CHANGES IN EXISTING LAW MADE BY S. 1464 AS REPORTED

In compliance with paragraph 12 of rule XXVI of the Standing Rules of the Senate, changes in existing law made by the bill, as reported, are shown as follows (existing law proposed to be omitted is enclosed in black brackets, new matter is printed in italic, existing law in which no change is proposed is shown in roman):

TITLE 38-UNITED STATES CODE

PART I-GENERAL PROVISIONS

CHAPTER 1-GENERAL

§ 111. Travel expenses

(a)

(b)(1) Except as provided in subsection (g) of this section and notwithstanding subsection (f)(2)(A) of this section or any other provision of law, if, with respect to any fiscal year, the Administrator exercises the authority under this section to make any payments, the Administrator, in such fiscal year, shall make the payments provid ed for in this section, subject to any applicable deduction under paragraph (2) of this subsection, to or for the following persons for travel for examination, treatment, or care:

(A) A person receiving benefits under this title for or in connection with a service-connected disability.

(B) A veteran receiving pension under section 521 of this title. (C)(i) A veteran whose annual income, determined in accordance with section 503 of this title, does not exceed the maximum annual rate of pension which would be payable to such veteran if such veteran were eligible for pension under section 521 of this title, or (ii) a veteran who is determined, under regulations prescribed by the Administrator, to be unable to defray the expenses of the travel for which payment under this section is claimed.

(D) A veteran whose travel to a Veterans' Administration facility was incident to a scheduled compensation and pension examination.

(2)(A) Except as provided in subparagraph (B), (C), or (D) of this paragraph, the Administrator, in making a payment under this section to or for a person described in subparagraphs (A), (B), or (C) of paragraph (1) of this subsection for travel for examination, treatment, or care, shall deduct from the amount otherwise payable an amount equal to $3.75 for one-way each trip.

(B) In the case of a person who is determined by the Administrator to be a person who is required to make six or more one-way trips

for needed examination, treatment, or care during the remainder of the calendar month in which the determination is made or during any subsequent calendar month during the one-year period following the last day of the month in which the determination is made, the amount deducted by the Administrator pursuant to subparagraph (A) of this paragraph from payments for trips made to or from such facility during any such month shall not, except as provided in subparagraph (D) of this paragraph, exceed $22.50.

(C) No deduction shall be made pursuant to subparagraph (A) of this paragraph in the case of a person whose travel to or from a Veterans' Administration facility was required to be performed by a special mode of travel and such travel (i) was authorized by the Administrator before such travel was commenced, or (ii) was in connection with a medical emergency of such a nature that the delay incident to obtaining authorization under clause (i) of this subparagraph would have been hazardous to the person's life or health. In the case of such travel, if the Administrator determines that providing payment prior to determining the eligibility of such person is in the best interest of furnishing care and services, the Administrator may so provide payment to the provider of the transportation subject to subsequently recovering from such person the amount of the payment if such person is determined to have been ineligible for payment for such travel.

(D) Whenever the Administrator increases or decreases the rates of allowances or reimbursement to be paid under this section, the Administrator shall, effective on the date on which such increase or decrease takes effect, adjust proportionately the dollar amounts specified in subparagraphs (A) and (B) of this paragraph as such amounts may have been increased or decreased pursuant to this subparagraph prior to such date.

[(b)(c) Payment of the following expenses or allowances in connection with vocational rehabilitation, counseling, or upon termination of examination, treatment, or care, may be made before the completion of travel:

(1) the mileage allowance authorized by subsection (a) hereof; (2) actual local travel expenses;

(3) the expense of hiring an automobile or ambulance, or the fee authorized for the services of a nonemployee attendant. [(c)](d) When any person entitled to mileage under this section requires an attendant (other than an employee of the Veterans' Administration) in order to perform such travel, the attendant may be allowed expenses of travel upon the same basis as such person. [(d)](e) The Administrator may provide for the purchase of printed reduced-fare requests for use by veterans and their authorized attendants when traveling at their own expense to or from any Veterans' Administration facility.

[(e)](1) In carrying out the purposes of this section, the Administrator, in consultation with the Administrator of General Services, the Secretary of Transportation, the Comptroller General of the United States, and representatives of organizations of veterans, shall conduct periodic investigations of the actual cost of travel (including lodging and subsistence) to beneficiaries while traveling to or from a Veterans' Administration facility or other place pursuant to the provisions of this section, and the estimated

cost of alternative modes of travel, including public transportation and the operation of privately owned vehicles. The Administrator shall conduct such investigations immediately following any alteration in the rates described in paragraph (3)(C) of this subsection, and, in any event, immediately following the enactment of this subsection and not less often than annually thereafter, and based thereon, shall determine rates of allowances or reimbursement to be paid under this section.

(2) In no event shall payment be provided under this section— (A) unless the person claiming reimbursement has been determined, pursuant to regulations which the Administrator shall prescribe, to be unable to defray the expenses of such travel (except with respect to a person receiving benefits for or in connection with a service-connected disability under this title, a veteran receiving or eligible to receive pension under section 521 of this title, or a person whose annual income, determined in accordance with section 503 of this title, does not exceed the maximum annual rate of pension which would be payable to such person if such person were eligible for pension under section 521 of this title);

(B) to reimburse for the cost of travel by privately owned vehicle in any amount in excess of the cost of such travel by public transportation unless (i) public transportation is not reasonably accessible or would be medically inadvisable, or (ii) the cost of such travel is not greater than the cost of public transportation; and

(C) in excess of the actual expense incurred by such person as certified in writing by such person.

(3) In conducting investigations and determining rates under this section, the Administrator shall review and analyze, among other factors, the following factors:

(A) (i) Depreciation of original vehicle costs;

(ii) gasoline and oil costs;

(iii) maintenance, accessories, parts, and tire costs;

(iv) insurance costs; and

(v) State and Federal taxes.

(B) The availability of and time required for public transportation.

(C) The per diem rates, mileage allowances, and expenses of travel authorized under sections 5702 and 5704 of title 5 for employees of the United States.

(4) Before determining rates or adjusting amounts under this section and not later than sixty days after any alteration in the rates described in paragraph (3)(Č) of this subsection, the Administrator shall submit to the Committees on Veterans' Affairs of the House of Representatives and the Senate a report containing the rates and amounts the Administrator proposes to establish or continue with a full justification therefor in terms of each of the limitations and factors set forth in this section.

(g)(1) Whenever the Administrator exercises with respect to any fiscal year the authority to make payments under this section, the Administrator shall, not later than the fifteenth day after the date on which the Administrator so exercises such authority or the first day of such year, whichever is the later, make an allocation to each

Veterans' Administration medical facility sufficient to enable the head of such facility to make such payments during the portion of the year beginning on the first day as to which the authority is exercised and ending on the last day of such year to persons eligible for such payments under subsection (b) of this section.

(2)(A) In any fiscal year in which funds are allocated pursuant to paragraph (1) of this subsection, the head of each such facility, unless granted a waiver under subparagraph (B) of this paragraph and regulations which the Administrator shall prescribe thereunder, shall utilize such funds solely for the purpose of making payments under this section.

(B)(i) In any case in which the head of such a facility demonstrates to the Chief Medical Director that, on April 12, 1987, such facility was making payments under this section at an annual expenditure less than the annual expenditure level would have been if such payments were being made to all eligible persons in the maximum amounts then authorized under this section, the Chief Medical Director shall waive provisions of subsection (b) of this section and authorize payments to be made at any such prior level or at any higher level, proposed by such facility head, that is less than the level that would otherwise be provided for under this section.

(ii) In any other case in which the head of such a facility proposes to make payments under this section at an annual expenditure level less than the level that would otherwise be provided for under this section, if the Chief Medical Director determines that making payments at such lesser level, or any higher level that is less than the level that would otherwise be provided for under such subsection, would be in the best interest of furnishing care and services to eligible veterans at such facility, the Chief Medical Director may waive the provisions of subsection (b) of this section and authorize payments to be made at the level specified in the Chief Medical Director's determination.

(C) Any funds which are allocated to a facility pursuant to paragraph (1) of this section for the purpose of payments under this section but which, pursuant to a waiver granted under subparagraph (B) of this paragraph, are not expended for such purpose shall be available to the head of such facility to be expended for direct pa

tient-care services.

(h)(1) The Administrator, in consultation and coordination with the Secretary of Transportation and appropriate representatives of veterans' service organizations, shall take all appropriate steps to facilitate the establishment and maintenance of a program under which such organizations, or individuals who are volunteering their services to the Veterans' Administration, would take responsibility for the transportation, without reimbursement from the Veterans' Administration, to Veterans' Administration facilities of veterans, primarily those residing in areas which are geographically accessible to such facilities, who seek services or benefits from the Veterans' Administration under chapter 17 or other provisions of this title.

(2) Not later than 6 months after the date of the enactment of this subsection, the Administrator shall submit to the Committees on

Veterans' Affairs of the Senate and the House of Representatives a report on the implementation of this subsection.

CHAPTER 3-VETERANS' ADMINISTRATION; OFFICERS AND

EMPLOYEES

SUBCHAPTER V-OTHER VETERANS' ADMINISTRATION OFFICES

250. Assistant Inspector General for Health Care Quality Assurance Review.

SUBCHAPTER V-OTHER VETERANS' ADMINISTRATION OFFICES

$250. Assistant Inspector General for Health Care Quality Assurance Review

(a) There is established in the Veterans' Administration Office of the Inspector General, in addition to the positions of Assistant Inspector General of the Veterans' Administration provided under section 3(d) of the Inspector General Act of 1978 (5 U.S.C. App. 3), the position of Assistant Inspector General for Health Care Quality Assurance Review.

(b) The Administrator shall make available to the Office of the Inspector General sufficient resources to provide for an Assistant Inspector General for Health Care Quality Assurance Review and the personnel required by subsection (d) of this section and to enable such Assistant Inspector General and personnel to perform the duties of such Assistant Inspector General.

(c) The Assistant Inspector General for Health Care Quality Assurance Review shall be a qualified doctor of medicine appointed by the Inspector General of the Veterans' Administration.

(d) The staff of the Assistant Inspector General for Health Care Quality Assurance Review shall include the following:

(1) Not less than two qualified doctors of medicine.

(2) Not less than one qualified doctor of dental surgery or dental medicine.

(3) Not less than one qualified registered nurse.

(4) Not less than one attorney who has expertise in healthcare law.

(5) Not less than one individual who has expertise in healthcare quality assurance and risk management.

(6) Not less than one individual who has expertise in healthcare administration.

(7) A sufficient number of support and additional personnel, but not less than the equivalent of five full-time personnel, to enable the Assistant Inspector General for Health Care Quality Assurance Review to perform the duties of such Assistant Inspector General.